Provider Demographics
NPI:1124277561
Name:ADVENTIST HEALTHCARE
Entity type:Organization
Organization Name:ADVENTIST HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:BALLENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-592-4409
Mailing Address - Street 1:12041 BOURNEFIELD WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7907
Mailing Address - Country:US
Mailing Address - Phone:301-592-4500
Mailing Address - Fax:301-592-4406
Practice Address - Street 1:12041 BOURNEFIELD WAY
Practice Address - Street 2:SUITE B
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7907
Practice Address - Country:US
Practice Address - Phone:301-592-4500
Practice Address - Fax:301-592-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1033163W00000X, 164W00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty